Proximal Humerus Internal Locking System Research Articles

"Management of Neer Type of Humerus Fracture by Proximal Humerus Internal Locking System (Philos) Plate"

"Management of Neer Type of Humerus Fracture by Proximal Humerus Internal Locking System (Philos) Plate"

Study of Functional Outcome and Postoperative Complications Among Proximal Humerus Fracture Patients Treated With Proximal Humerus Internal Locking System (PHILOS) Plating.

Background Proximal humerus fractures comprise nearly 4%-5% of all fracture types and nearly 25% of fracture humerus. These fractures are commonly seen in the elderly population (people aged 60 years or more). The best way to treat elderly people who have three- or four-part fractures of the proximal humerus is debatable, with many in favour of prosthetic humeral head replacements. This study aimed to assess the functional outcome of proximal humerus fractures managed with a proximal humerus locking plate and to investigate the incidence of complications in these patients. Methodology This retrospective study included 32 cases of proximal humerus fractures managed surgically at a tertiary care teaching hospital in Rajasthan between July 2016 to July 2022 with a proximal humerus internal locking system (PHILOS) plate. NEER scoring system was used to categorise the fractures. Functional assessment was done using Constant Murley's shoulder score. Constant Murley shoulder score was graded as failure (0-69 points), unsatisfactory (70-79), satisfactory (80-89), and excellent (90-100). Subjects having metastatic and pathological fractures; associated fractures in the ipsilateral limb; having major nerve injury and cases of open fracture were excluded from this study. Results The mean age was 54.5±6.4 years. Of the total 32 cases of proximal humerus fractures, 12 cases of two-part fractures received an excellent grade, compared to seven cases of three-part fractures. Three two-part fracture cases and two three-part fracture cases all received satisfactory grades. Excellent results (score > 89) were noticed in 62.5% (n = 20) of the instances, satisfactory results (scoring 80-89) in 21.87% (n=7), poor results (score 70-79) in 9.38% (n=3), and failure results (score 70) in 6.25% (n=2). In 65.6% of cases, follow-up showed no complications. Shoulder stiffness and malunion (9.38%) were the most frequent consequences, followed by avascular necrosis (6.25%). Conclusions Based on the findings of this retrospective study, it can be opined that PHILOS plaiting appears to be a secure option for proximal humerus fracture cases. It offers solid fixation, prompt mobilisation, and excellent functional outcomes as observed in this study. Additionally, very few post-operative complication rates again support our conclusion.

Outcome of Neer Type 3 & 4 Fractures of Humeral Head Treated with Proximal Humerus Internal Locking System (PHILOS) Plate Osteosynthesis

Objective: To assess the outcome of Neer type 3 and 4 fractures of humeral head treated with Proximal Humerus Internal Locking System (PHILOS) plating. Study Design: Descriptive case series. Place and Duration: This study was conducted in The Department of Orthopaedics and Spine Surgery, Lahore General Hospital, Postgraduate Medical Institute, Lahore Pakistan from 1st September 2020 to 30th March 2022. Methodology: A total of 30 patients aged between 18-60 years presenting with displaced three and four parts fractures of proximal humerus were analyzed. At the time of enrollment, demographic data was noted and medical history was taken. All fractures were classified with the help of plain radiographs. All patients underwent PHILOS Plate osteosynthesis as per standard surgical approach. The patients were followed up till 6-months. Final outcomes were labeled in terms of total constant score and functional outcome. Results: In a total of 30 cases, 73.3% were male while overall mean age was 36.73±12.85 years. There were 56.7% patients who had road traffic accident and 36.7% reported fall from height and 6.7% patients had physical assault (hit by bull). The mean duration of surgical procedure was 59.57±19.39 minutes while the mean duration of hospitalization was 5.50±2.17 days. The mean constant score was 72.76±12.25. The functional outcome of patients after 6 months were excellent in 10.0% patients, good 40.0% and 50.0% had fair outcome. There were 93.3% patients who had grade-1 union and 6.7% had grade-2 union after 6 months of follow up. Conclusion: Very acceptable functional outcomes with PHILOS plating were found in Neer type 3 and 4 fractures of humeral head. Early mobilization of shoulder can be achieved without any compromise in fracture union with six months follow and there was no avascular necrosis. Keywords: Accidents, Hospitalization, Humerus, Necrosis, Shoulder, Surgical Procedures, Proximal Humerus Internal Locking System (PHILOS) Plating How to Cite This: Ijaz A, Basit MA, Hussain R, shakeel M, Hanif M. Outcome of Neer Type 3 & 4 Fractures of Humeral Head Treated with Proximal Humerus Internal Locking System (PHILOS) Plate Osteosynthesis. Isra Med J. 2023; 14(4): 139-142. DOI: https://doi.org/10.55282/imj.oa1349

TREATMENT OF PROXIMAL HUMERUS FRACTURES USING PHILOS PLATE: A RETROSPECTIVE REVIEW OF RECORDS IN A TERTIARY CENTER IN NEPAL

Introduction Treatment of proximal humerus fractures always holds a dilemma for the treating surgeon. Many treatment options are available for its management. This retrospective review of records aimed to assess the functional outcome of proximal humerus fractures treated with Proximal Humerus Internal Locking System (PHILOS) plating. Fifty-three consecutive patie Material and Methods nts were treated with PHILOS plating between August 2019 to August 2021. Adults 18-65 years with displaced closed fracture proximal humerus (displacement >1 cm and varus angulation of >45) who underwent xation with PHILOS plate were included in this study. Severely comminuted fractures, open fractures and valgus impacted fractures were excluded from the study. Patients with additional injuries to ipsilateral limb and other systems were also excluded. Neer's scoring system was recorded for visit at 3,6 and 12 weeks The average Results age was 54.3±5.8 years. As per the Neers classication system, there were 6 (11.32%) 1-part, 19 (35.85%) 2-part, 17 (32.085) and 11 (20.75%) 3 and 4-part fracture respectively. Average surgical duration was 94±10.2 minutes. Radiological union was seen at 12±4.6 weeks. There were 2 (3.77%) cases of varus collapse. Three (5.66%) cases had screw back out, which was later revised and had a favorable outcome. As per the Neer's scoring system, 7 (13.21%) cases had excellent results, 37 (69.81%) had satisfactory, 6 (11.32%) had unsatisfactory while 3 (05.66%) cases had poor outcomes. PHILOS plating has a good Conclusion functional outcome. However, proper patient selection, thorough knowledge of the anatomy and biomechanical principles are the pre-requisites for a successful surgery.

COMPARATIVE STUDY SHOWING FUNCTIONAL OUTCOME OF PROXIMAL HUMERUS FRACTURE FIXATION WITH PHILOS PLATING V/S PERCUTANEOUS K-WIRE FIXATION.

Background: There is still a lot of debate, regarding the most effective ways to treat displaced proximal humerus fractures. Numerous xing techniques been developed for proximal humerus fractures (like percutaneous pinning, tension band wiring, screw xation, conventional plate, T buttress plate, locking plate, prosthetic replacement). Close reduction & percutaneous k-wire xation having advantage being minimal invasive, less soft tissue stripping, with less blood loss, hence useful in elderly patients. But implant of choice for treating displaced proximal humerus fractures is locking plate because it provides absolute anatomical xation with angular stability. This study evaluates prospectively, the functional outcome following PHILOS vs percutaneous pinning in proximal humerus fractures. 30 patie Methods: nts were enrolled for study based on OPD & trauma centre admissions based on inclusion & exclusion criteria. Patients were grouped into two groups based on consecutive sampling. Group A (15 Patients) {ODD} includes rst patients, Group B (15 Patients) {EVEN} includes second patients. Group A operated with proximal humerus internal locking system (PHILOS), & Group B with percutaneous K-wire xation. Functional outcome was assessed by NEER's Score. Results: Functional outcome at end of 6 months, based on Neer's Score, in group A, came out to be excellent in 12 (80%) and satisfactory in 3 (20%). In group B, excellent in 5 (33.3%) and satisfactory in 10 (66.6%). In Group A, 2 patients developed complications i.e., 1 patient had shoulder stiffness & 1 patient had supercial infection. In Group B, 6 patients developed complications i.e., 4 patients had shoulder stiffness only, 1 patient had supercial infection only and 1 patient had both shoulder stiffness and supercial infection. PHILOS plate provides excellent Conclusion: functional outcome with minimal complications for displaced proximal humerus fractures compared to percutaneous k wire xation

Comparison of Functional Outcome and Union of Proximal Humerus Fractures Fixed with Philos Plate Versus T Plate

Aim: The purpose of this study was to evaluate the differences between PHILOS and T plates in terms of functional recovery and fracture union after proximal humerus fractures. Study Design: Prospective study Place and Duration: Bahawal Victoria Hospital, Bawalpur/Nishtar Hospital, Nishtar Medical University, Multan. Jun 2020-January 2022 Methods: There were a total of 48 patients, both sexes, ranging in age from 20 to 75. All the included patients had humerus fractures and admitted to hospital for operation. Age, sex, BMI, fracture aetiology, and fracture side were recorded together with other pertinent demographic information after obtaining written consent from the patients. Patients were equally divided in two groups. Group I received Proximal Humerus Internal Locking System (PHILOS) in 24 cases and group II 24 cases received T platting. Patients were followed for 12-months. Post-operative functional and union outcomes among both groups were assessed. We used SPSS 26.0 to analyze all data. Results: There were 36 (75%) male patients and 12 (25%) females among all cases. In group I mean age was 47.9±8.42 years with mean BMI 23.6±4.23 kg/m2 while in group II mean age was 50.3±7.29 years and had mean BMI 24.5±3.42 kg/m2.RTA was the most common etiology found in group I 13 cases and 12 cases in group II. Right was the most common affected side among all cases 15 in group I and 14 in group II. Mean operative time of T plates 131.3±12.16 minutes were higher as compared to PHILOS 121.2±17.40 minutes. Blood loss was also higher in T plates as compared to PHILOS with p value <0.003. As per functional results, group I showed higher frequency of excellent and good results (16.7%, 54.2%) as compared to group II (8.3%, 41.7%). Mean union time was lower in group I 11.6±5.33 weeks as compared to group II 15.8±2.52 weeks. Post-operative complications by using T plates were found higher 6 (25%) as compared to group PHILOS group 3 (12.5%). Conclusion: We concluded in this study that PHILOS platting for the fixation of proximal humerus fractures were effective and useful in terms of less blood loss, less operative time, less union time and higher number of excellent and good results as compared to T platting. Except this complications were also found lower in PHILOS platting group. Keywords: Proximal Humerus Fracture, PHILOS Plate, T Plate, Complications, Functional outcomes

Effectiveness analysis of proximal humerus internal locking system plate combined with rotator cuff reinforcement suture in treatment of Neer type Ⅳ proximal humerus fracture

To investigate the effectiveness of proximal humerus internal locking system (PHILOS) plate combined with rotator cuff reinforcement suture in the treatment of Neer type Ⅳ proximal humerus fracture. The clinical data of 48 patients with proximal humeral fractures admitted between January 2016 and December 2020 were retrospectively analyzed, including 18 males and 30 females. The age ranged from 28 to 69 years (mean, 56.3 years). The causes of injury included falling in 39 cases and traffic accident in 9 cases. The time from injury to operation was 2-5 days (mean, 2.8 days). All of them were Neer type Ⅳ proximal humerus fractures, including 11 patients with dislocation. All patients underwent internal fixation with a PHILOS plate after anatomical reduction of the greater nodule, and the rotator cuff was sutured to the plate to reinforce fixation. The operation time was recorded, the wound healing, fracture healing, and complications were observed. The visual analogue scale (VAS) score, Constant-Murley shoulder score, University of California Los Angeles (UCLA) score, and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder function before operation, at 3 months after operation, and at last follow-up. The operation time ranged from 65 to 90 minutes (mean, 76.9 minutes). All incisions healed by first intention. All patients were followed up 9-16 months (mean, 12 months). Fracture reduction was good and all fractures healed, the healing time was 2-6 months (mean, 4.6 months). There was no complication such as subacromial impingement, fracture redisplacement, and screw removal during follow-up. One patient had humeral head necrosis, but the basic function of the shoulder joint was acceptable, the symptoms were mild, and no treatment was performed. At 3 months after operation, the upper limb function of the patients basically recovered. The VAS score, Constant-Murley score, UCLA score, and ASES score significantly improved at 3 months after operation and at last follow-up when compared with preoperative, and further improved at last follow-up than at 3 months after operation ( P<0.05). PHILOS plate combined with rotator cuff reinforcement suture in the treatment of Neer type Ⅳ proximal humerus fracture has the advantages of promoting early postoperative rehabilitation exercise, improving postoperative function of shoulder joint, and reducing complications.

A comparative study to assess the functional outcome in proximal humerus fractures treated surgically with philos plate (Proximal humerus internal locking system) and percutaneous k-wire fixation

Background: Proximal humerus fractures are common and debilitating injuries and incidence of them are increasing especially in elderly. Treatment of unstable, displaced, and comminuted fractures of the proximal humerus remains challenging. Significant controversy continues regarding the best methods of treating displaced proximal humerus fractures. Fracture classification has been inconsistent and surgical treatment have been variable. Most studies indicate that for the majority of good results of fractures of this region are obtained by conservative methods. Some studies state that operative treatment is better, depending on type of fracture and the quality of the bone. This present study is aimed to assess the functional outcome in proximal humerus fractures treated surgically with PHILOS (Proximal Humerus Internal Locking System) plate and percutaneous K-wire fixation in the indicated group of patients. Aim: To assess the functional outcome in proximal humerus fractures treated surgically with PHILOS (Proximal Humerus Internal Locking System) plate and percutaneous K-wire fixation in the indicated group of patients. Methods: This is a prospective study, period from December 2019 to August 2021, and a minimum of 50 sites of proximal humerus fractures were attended in the casualty and OPD were evaluated clinically and radiographically. Results: Functional assessment using NEER’s score was found to be significantly more in group A subjects as compared to group B subjects at 6 weeks, 12 weeks and 6 months. At 6th week, TRU score was found to be significantly more in Group B subjects as compared to Group A subjects.

Evaluation of Proximal Humerus Internal Locking System in Management of Proximal Humeral Fractures

Evaluation of Proximal Humerus Internal Locking System in Management of Proximal Humeral Fractures

Fibula Strut Autograft With Locking Plate Construct In Comminuted Proximal Humerus Fractures

he aim of this study is to evaluate the functional and radiological outcome of comminuted PHF’s managed operatively with open reduction and internal fixation (ORIF) using proximal humerus internal locking system (PHILOS) augmented with intra-medullary fibular strut autograft.

Assessment of Surgical Outcome in Three- and Four-Part Proximal Humerus Fracture Treated With Proximal Humerus Internal Locking System (PHILOS) Plate Versus Neer's Prosthesis in Elderly Patients.

Background: With an incidence of 50% of humerus fractures, proximal humerus fractures (PHFs) can significantly impact one’s quality of life. Moreover, management of highly comminuted or displaced PHFs poses a significant challenge amongst elderly population due to poor bone quality. Prosthetic replacement of humeral head or its stabilization using external plates is a commonly employed intervention for treating three- and four-part PHFs. Thus, these two methods were compared in this study to identify a preferable intervention.Methods: Patients were randomly divided into two groups to receive proximal humerus internal locking system (PHILOS®, Synthes, Switzerland) plating and Neer’s hemiarthroplasty. The deltopectoral approach was deployed as the surgical method. Their surgical outcome was assessed from functional range of motion (ROM) and Constant-Murley scores at regular intervals of three, six, twelve, and twenty-four weeks.Results: Twenty patients were divided into two groups who received PHILOS® plating and Neer’s hemiarthroplasty, averaged 67.2 years and 72.8 years. The ROM pertaining to flexion, extension, abduction, internal rotation, and external rotation for individuals with PHILOS® plating was 20%, 12.5%, 14.7%, 11.5%, and 18.5% higher than those who received Neer’s hemiarthroplasty. Moreover, the Murley score was also 8.7 units higher for individuals with PHILOS® plating.Conclusions: Prognosis following PHILOS® plate osteosynthesis had a better overall outcome than hemiarthroplasty with Neer’s prosthesis. Although hemiarthroplasty yielded a consistent functional outcome, PHILOS® plate osteosynthesis tends to restore a greater ROM. Thus, PHILOS® plating is recommended as the suitable method to manage three- and four-part PHF for people above fifty-five years of age.

To assess the functional outcome of proximal Humerus Fractures treated with Proximal Humerus Internal Locking System (PHILOS) platingIn Elderly age Group Population

To assess the functional outcome of proximal Humerus Fractures treated with Proximal Humerus Internal Locking System (PHILOS) platingIn Elderly age Group Population

COMPARATIVE EVALUATION OF FUNCTIONAL OUTCOME OF OPEN REDUCTION AND INTERNAL FIXATION WITH PHILOS AND CLOSED REDUCTION AND PERCUTANEOUS FIXATION WITH K-WIRES IN PROXIMAL HUMERAL FRACTURES

Background: Fracture of the proximal humerus represents the second most common (29.1%) fracture type in the upper extremity after Colle's fracture (37.2%) of the wrist. Signicant controversy continues regarding the best modality for treating displaced proximal humerus fractures. The objective of our study is to comparatively evaluate the functional outcome of ORIF with Proximal Humerus Internal Locking System (PHILOS) and Close Reduction and Percutaneous Fixation with K-wires in proximal humerus fractures. Method: A prospective study was conducted after getting ethical approval at N.S.C.B. Medical College &amp; Hospital, Jabalpur, (M.P.) upon 50 cases admitted with proximal humerus fractures as per inclusion criteria. 25 cases were treated with PHILOS plate in group A and 25 patients were treated with Closed Reduction and Percutaneous Fixation with K-wires in group B. Post op follow up was done at 6 weeks and 12 weeks and functional outcome evaluated by Neer's scoring criteria. Results: Out of 50 cases, excellent scores was obtained in 22 (88%) cases treated with PHILOS in group A, and 18 (72%) cases treated with k-wire xation in group B, satisfactory score was obtained in 3 (12%) in Group A and 6 (24%) in Group B. Conclusion: We obtained excellent results in both groups with each procedure having its own advantage and disadvantages. We found that PHILOS provides secure xation with better functional outcome in terms of range of motion. Fixation with Percutaneous K-wires is also efcient treatment option with intraoperative advantage in terms of invasiveness, blood loss and time taken for surgery with least tissue dissection than PHILOS plating

Non Vascularised Fibula Strut Graft Augmentation for Fixation of Proximal Humerus 3-Part Fracture using PHILOS Plate and CC Screws in a Young Male

Proximal humerus fracture accounts for 4-5% of all fractures. Locking Compression Plate (LCP) Proximal Humerus Internal Locking System (PHILOS) fixation is currently the most widely used method for the management of unstable proximal humerus fractures. LCP system of the proximal humerus is better than other available implants because of better anatomic design, fixed angulated configuration of locking screws, rotational and angular stability. This case report was of a 35-year-old male who presented with pain, swelling and difficulty in movement at the right shoulder, after a road traffic accident. Plain radiograph of right shoulder (anteroposterior) view revealed displaced 3-part proximal humerus fracture (humeral head with lesser tuberosity, greater tuberosity and shaft). It was managed with philos plate, Cannulated Compression (CC) Screws and non vascularised fibular strut graft. At two years follow-up, patient showed good shoulder range of motion with no complication.

Biomechanical evaluation of a modified proximal humeral locking plate application for distal extra-articular diaphyseal humeral fractures.

The extra-articular distal humerus locking plate (EADHP) is widely used for distal extra-articular diaphyseal humeral fracture fixation. However, it occasionally causes skin prominence and discomfort. The upside-down use of a proximal humerus internal locking system (PHILOS) plate is suggested as an alternative option, but it lacks biomechanical evidence. The purpose of this study was to compare the biomechanical performance between two different fixation methods: themodified use of the PHILOS plate on the anterior cortex versus conventional use of an EADHP on the posterior cortex. Twelve pairs of fresh-frozen cadaveric humeri were used and 7 mm gap osteotomy was performed at 50 mm proximal to the lateral epicondyle to simulate an AO/OTA 12-C1.3 fracture type. Single load to failure was measured after five stiffness tests of the plate-bone constructs in anterior/posterior bending, internal/external torsion, and axial compression. There were no significant differences in metrics between the two groups, except for the load to failure in posterior bending, which was significantly higher for PHILOS (1589.3 ± 234.5) compared to EADHP (1430.1 ± 188.6), p < .023. In conclusion, the modified use of the PHILOS plate showed comparable biomechanical performance compared to the conventional EADHP. The new fixation method offers potential clinical advantages, considering the patient's position and surgical approach at the time of surgery as well as postoperative soft tissue irritation. Therefore, this could be an option for distal humeral extra-articular diaphyseal fracture fixation when the use of EADHP is not suitable or preferred.

Assessment of the functional outcome of proximal humerus fracture following “PHILOS” plating

Objective: The aim of our study was to evaluate the functional outcome using Constant-Murley scoring and grading system and complications of proximal humeral fractures in the elderly Indian population treated with proximal humerus internal locking system (PHILOS). Method: A prospective study was carried out in a tertiary care center in Kolhapur. A total number of 46 patients with fracture of proximal humerus (NEERs 2 part, 3part & 4part) were studied between January 2019 and Oct 2020. All were treated with PHILOS via deltopectoral approach. A mean follow up of 12 months was carried out, and evaluation was done with the help of Constant-Murley scoring and grading system. Result: The mean radiological union time was 16 weeks. The outcome was measured using Constant-Murley scoring and grading system. Average follow up period was 12 months with good patient satisfaction. Total of 11 patients out of 46 reported complications like Malunion (4.50%), Shoulder Joint Stiffness (17.80%), Infection (8.90%) and Implant Loosening (2.20%). No case of peripheral neuropathies reported in any of the patients. Conclusion: PHILOS plating via deltopectoral approach is a good treatment option showing good clinical outcome in the treatment of proximal humerus fracture (NEERs 2/3/4 part). It offers a more stable fixation and deltopectoral approach gives better exposure for the surgery.

The functional outcome of proximal humerus fracture treated with proximal humerus internal locking osteosynthesiss (PHILOS) plating

To assess the functional outcome of proximal humerus fractures treated with Proximal Humerus Internal Locking System (PHILOS) plating. 40 consecutive patients were treated with PHILOS plating. The inclusion criteria were skeletally matured patients with closed fracture of proximal humerus. The outcome was assessed using Neer's scoring system. As per the Neers classification system, there were 1-part, 2-part, 3 and 4-part fracture respectively. However, proper patient selection, thorough knowledge of the anatomy and biomechanical principles are the pre-requisites for a successful surgery.

Comparison of optimal screw configurations in two locking plate systems for proximal humerus fixation - a finite element analysis study

BackgroundManagement of proximal humerus fractures is challenging, especially in elderly. Locking plating is a common surgical treatment option. The Proximal Humerus Internal Locking System (plate-A) has shown to lower complication rates compared to conventional plates, but is associated with impingement risk, which could be avoided using Peri-articular Proximal Humerus Plate (plate-B). Nevertheless, biomechanical performance and optimal screw configuration of plate-B is unknown. The aim of this study was to evaluate different screw configurations of plate-B and compare with plate-A using finite element analyses. MethodsTwenty-six proximal humerus models were osteotomised to create unstable three-part fractures, fixed with either of the two plates, and tested under three anatomical loading conditions using a previous established and validated finite element simulation framework. Various clinically relevant screw configurations were investigated for both plates and compared based on the predicted peri-implant bone strain, being a validated surrogate of cyclic cut-out failure. FindingsBesides increasing the number of screws, the placement of the posterior screws in combination with the calcar screw in the plate-B significantly decreased the predicted failure risk. Generally, plate-A had a lower predicted failure risk than plate-B. InterpretationThe posterior and calcar screws may be prioritized in plate-B. Compared to plate-A, the more distal positioning, less purchase in the posterior aspect and a smaller screw spread due to not fitting of the most distal calcar screw in most investigated subjects led to a significantly higher predicted failure risk for most plate-B configurations. The findings of the simulations study require clinical corroboration.

Anterior minimally invasive plating osteosynthesis using reversed proximal humeral internal locking system plate for distal humeral shaft fractures.

To describe the surgical application of anterior minimally invasive plating osteosynthesis (MIPO) using reversed proximal humerus internal locking system (PHILOS) plate for multifragmentary distal humeral shaft fractures. Twelve patients with distal humeral shaft fractures (type 12B, n = 6 and type 12C, n = 6) were operated on by anterior MIPO and reversed PHILOS plate fixation. The amount of intact bone in the distal fragment was measured by fracture-to-coronoid distance (FCD). Data of the postoperative alignment, complications, union time, and clinical outcomes were collected. The mean time for fractures to unite in all patients was 14.8weeks (range 12-22). There was no perioperative complication. The mean FCD was 4.8cm (range 2.1-8.1). The mean coronal angulation was 3.4° (range 0-9), and the mean sagittal angulation was 1° (range 0-5). All patients had excellent UCLA shoulder score and MEP score results, and the mean range of elbow motion was 140° (range 130-145). Anterior MIPO using reversed PHILOS plate is safe and effective for multifragmentary fractures of the distal humeral shaft even in a fracture with a length of intact bone above the coronoid fossa of only 2cm.

Bilateral symmetrical anterior fracture dislocation of shoulder

&lt;p&gt;The incidence of simultaneous bilateral shoulder joint dislocation is rare and is almost always posterior usually caused by violent muscle contraction as in patients with seizure disorders or who experience electric shock or undergo electroconvulsive therapy. simultaneous bilateral fracture-dislocation is even rarer, with a few cases reported in the literature. We report an unusual case with dislocation of the both shoulder joints in anterior direction after a seizure episode, With symmetrical unifocal 2-part extraarticular vertical fracture of proximal end segment of humerus (11A3) both sides. Although there have been a few reports of bilateral symmetrical fracture dislocations of the shoulder in the past, an injury pattern resembling our case has, to the best of our knowledge, not been described in the literature so far. Our report describes regarding the mechanism of injury in a case of a bilateral symmetrical anterior fracture dislocation following a seizure episode that treated with open reduction internal fixation using proximal humerus internal locking system (PHILOS). At final follow-up, the patient had healed fractures, painless near normal range of motion.&lt;/p&gt;